The current Pancreatic Cancer (PC) therapeutics market is very limited,
with only four drugs approved for the treatment of the disease. These
are the generics gemcitabine and fluorouracil (5-FU) and the patented
drugs Tarceva, by Genentech and Roche, and Abraxane, by Celgene.
Abraxane was approved by the US Food and Drug Administration (FDA) in
September 2013 and by the European Medicines Agency (EMA (News - Alert)) in January
2014 (FDA, 2013).

Since 1997, the standard of care in the treatment of advanced PC
(aproximately 80% of patients are diagnosed with advanced disease) has
been gemcitabine therapy, either as a monotherapy or in combination. In
combination, gemcitabine is often prescribed with off-label drugs that
cause minor improvements in progression-free survival, and trends
towards (although not statistically significant) OS - for example,
Xeloda and Eloxatin. Either in combination or as a monotherapy, average
Overall Survival (OS) with gemcitabine-based therapy is six months,
while the five-year survival rate is less than 5%. The recently approved
Abraxane has been shown, when in combination with gemcitabine, to
increase OS to 8.5 months (Von Hoff et al, 2011). The FOLFIRINOX
regimen, which uses a combination of folinic acid, 5-FU, irinotecan and
oxaliplatin, has been shown to increase OS in advanced PC patients to 11
months, but only in those with a good performance status.

Even with Abraxane's and the FOLFIRINOX regimen's recent improvements in
survival demonstrated with Abraxane and FOLFIRINOX, prognosis and
survival chances are still substantially worse in PC than for other
leading causes of cancer-related deaths, such as breast and lung cancer.
There are noticeable gaps in treatment development, namely a lack of
diagnostic tools and a lack of patient subset analysis and targeted
therapies. As such, the marketed products are expected to remain
dominated by gemcitabine and the off-label use of other chemotoxic
agents, throughout the 2014-2020 forecast period.